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Idaho rates for HCPCS J0290

Injection, ampicillin sodium, 500 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $6.99 / $88.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.59 / $0.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.52 / $0.55 / $0.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.72 / $1.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.61 / $2.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.88